High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke.

CONTEXT: Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE: We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. DESIGN: Cross Sectional. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S): Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages ("Unaware if have the policy", "Unaware for the need for the policy", "Unengaged", "Undecided", "Decided Not to Act", "Decided to Act", "Acting", and "Maintaining"). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. RESULTS: A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was "cool first transport second" with 74.1% (n=110) of ATs reporting "Acting" or "Maintaining." The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting "Decided not to Act" and 20.1% (n=72) reporting "Maintaining." The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. CONCLUSIONS: ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.

Extra-pulmonary manifestations of sarcoidosis.

Although, the diagnosis and evaluation of sarcoidosis has traditionally remained confined to the chest, its multi-system nature has been widely recognized. Radiological features of pulmonary sarcoidosis are well known but extra-pulmonary manifestations can produce a plethora of non-specific imaging findings that can affect subcutaneous tissue, and the neurological, cardiac, gastrointestinal, urological, liver, spleen, and skeletal systems. In the literature, there are various case reports and specific system reviews but there are few reviews that encompass all the extra-pulmonary manifestations. In this paper, we comprehensively review the imaging features of extra-pulmonary sarcoidosis with characteristic features as well as atypical presentations. In addition, we discuss the emerging role of nuclear medicine in sarcoidosis.

The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm.

We present a new MRI finding within the lumbar spine in a series of six patients admitted with CT proven subarachnoid haemorrhage (SAH) where cerebral angiography demonstrated no aneurysm and who had not had a lumbar puncture. A retrospective audit of 130 patients presenting to a regional neurosciences centre over a 13 month period with a suspected diagnosis of SAH was performed. Seven patients with proven SAH underwent MRI of the lumbar spine during the same admission. In six of these patients layering of haemorrhagic blood products was demonstrated within the lumbosacral spine. The process is analogous to the previously ubiquitous bedside erythrocyte sedimentation rate assay and has has been termed the "lumbar sedimentation" sign. This finding has not previously been reported in the literature in relation to SAH. While this is a small unselected group it may provide a useful adjunct in the diagnosis of SAH.

Imaging of illicit drug use.

Illicit drug abuse is a continuing menace of epidemic proportions associated with serious medical and social problems. Drug abuse can have a wide variety of presentations some of which can be life-threatening. The clinical diagnosis can be challenging as the history is usually limited or absent. Radiologists need to be familiar with varied imaging presentations and the related complications of illicit drug abuse to ensure correct diagnosis and appropriate timely treatment. This review will illustrate the imaging spectrum of illicit drug abuse involving several organ systems and also discuss the pathophysiological consequences of drug abuse.

Canine hip dysplasia treated by juvenile pubic symphysiodesis. Part II: two year clinical results.

OBJECTIVES: To determine the clinical effects of juvenile pubic symphysiodesis (JPS) treatment in hip dysplasia-prone puppies with comparison to similar untreated control puppies. DESIGN: Controlled clinical case study. ANIMALS: Thirty-nine dysplastic puppies, of which six were part of the control group, with a positive Ortolani or hip distraction index (DI)≥0.40. PROCEDURES: The following eight clinical tests were evaluated preoperatively, and at one and two years postoperatively: Ortolani, hip reduction angle (HRA), gait evaluation, osteoarthritis, hip pain, and three Norberg angles (angle-extended mode [N-OFA], angle-compression mode [N-COM], and angle-distracted mode [N-DIS]). Juvenile pubic fusion (JPS) was performed by unipolar electro-cautery at 12 to 24 weeks of age; the control puppies received a sham operation. RESULTS: For the JPS puppies, the mean osteoarthritis level did not significantly increase (11%). There was a 74% reversal of preoperative positive Ortolani signs. Hip reduction angle, DI and N-DIS also improved significantly. Only N-DIS fully detected Norberg angle laxity. Within the control group, osteoarthritis increased significantly (55%) with no improvement in Ortolani incidence, N-OFA or N-COM angles. A decrease in HRA and DI was associated with increased osteoarthritis levels. Signs of hip pain increased by 33%, which was not significant. Dogs with initial severe hip laxity (DI≥0.70) experienced progressive osteoarthritis. CONCLUSIONS AND CLINICAL RELEVANCE: In JPS dogs with preoperative mild to moderate hip laxity (DI = 0.40-0.69), insignificant osteoarthritis occurred at two years. Juvenile pubic symphysiodesis surgery also improved other clinical criteria (Ortolani, HRA, hip pain, N-DIS). Osteoarthritis was generally not prevented by JPS in dogs with initial severely lax hips (DI≥0.70). Juvenile pubic symphysiodesis surgery at 12 to 24 weeks of age was an effective and safe pre-emptive bilateral treatment for mild to moderate hip dysplasia.

Canine hip dysplasia treated by juvenile pubic symphysiodesis. Part I: two year results of computed tomography and distraction index.

OBJECTIVES: To measure one and two year effects of juvenile pubic symphysiodesis (JPS) in puppies defined as 'at-risk' for canine hip dysplasia (CHD) using the following objective hip conformation criteria: Acetabular angle (AA), dorsal acetabular rim angle (DARA) and hip laxity (PennHIP© distraction index (DI). DESIGN: Controlled clinical case study. ANIMALS: Thirty-nine dysplastic puppies (six controls). PROCEDURES: The dogs were anaesthetised and acetabular angle, DARA, and DI values were obtained by computed tomography and radiography preoperatively. Electro-cautery fusion of the pubic symphysis was performed between 12 - 24 weeks of age. The imaging was repeated at one and two years of age. RESULTS: Significant hip improvements were seen at the two-year follow-up appointments for: AA (JPS dogs 31% increase, control 3%), DARA (JPS 38% decrease, control 15%) and DI (JPS 41% decrease in laxity, controls 20%) for all postoperative versus preoperative values. Pubic fusion occurred with minor morbidity. CONCLUSION: Juvenile pubic symphysiodesis resulted in significant improvements in hip conformation (AA and DARA), especially in mild to moderately lax hips (DI = 0.40-0.69). Most dogs with DI≥0.70 increased in osteoarthritis grade by two years of age. CLINICAL RELEVANCE: Juvenile pubic symphysiodesis surgery at 12-24 weeks of age significantly improved hip conformation and decreased laxity in at-risk CHD dogs. Early-age (12 to 16 week) recognition of hip laxity offered greater JPS benefits than surgery performed at 19- to 24-weeks-old. Dogs with severe laxity (DI≥0.70) continued to increase in osteoarthritis. An early (12-16 weeks) positive laxity test (Ortolani) should alert one to obtain objective laxity determinations (PennHIP© DI).

One hundred questions of importance to the conservation of global biological diversity.

We identified 100 scientific questions that, if answered, would have the greatest impact on conservation practice and policy. Representatives from 21 international organizations, regional sections and working groups of the Society for Conservation Biology, and 12 academics, from all continents except Antarctica, compiled 2291 questions of relevance to conservation of biological diversity worldwide. The questions were gathered from 761 individuals through workshops, email requests, and discussions. Voting by email to short-list questions, followed by a 2-day workshop, was used to derive the final list of 100 questions. Most of the final questions were derived through a process of modification and combination as the workshop progressed. The questions are divided into 12 sections: ecosystem functions and services, climate change, technological change, protected areas, ecosystem management and restoration, terrestrial ecosystems, marine ecosystems, freshwater ecosystems, species management, organizational systems and processes, societal context and change, and impacts of conservation interventions. We anticipate that these questions will help identify new directions for researchers and assist funders in directing funds.

Imaging of Horner's syndrome.

Horner's syndrome, or oculosympathetic paresis, results from interruption of the sympathetic trunk innervation to the eye and presents typically with meiosis, ptosis and facial anhydrosis on the affected side.(1) The pathological process ranges from benign, such as cluster headache, or life threatening, such as lung malignancy. Appropriate imaging requires an anatomical appreciation of the complex and circuitous route the neuronal pathway takes as it passes from the central nervous system to the eye.

Ciclosporin use in multi-drug therapy for meningoencephalomyelitis of unknown aetiology in dogs.

OBJECTIVE: To evaluate the efficacy and safety of ciclosporin therapy alone or in combination with corticosteroids and/or ketoconazole in dogs with diagnosis of meningoencephalomyelitis of unknown aetiology. METHODS: Medical records of 10 dogs diagnosed with meningoencephalomyelitis of unknown aetiology and treated with ciclosporin therapy alone or in combination with corticosteroids and/or ketoconazole were reviewed at the Veterinary Medical Teaching Hospital, University of Wisconsin-Madison. Laboratory abnormalities, side effects, clinical and cerebrospinal fluid responses to treatment and association between blood ciclosporin level and response to treatment were evaluated. Histopathological diagnosis was available in three patients. RESULTS: No significant abnormalities were detected on serial complete blood count and serum chemistry panel in any of the dogs. Side effects of ciclosporin therapy included excessive shedding, gingival hyperplasia and hypertrichosis. Overall median survival time for all dogs in the study was 930 days (range, 60 to more than 1290 days). In all dogs, serial cerebrospinal fluid analysis showed a marked improvement in the inflammation. CLINICAL SIGNIFICANCE: Results suggest that ciclosporin either alone or in combination with ketoconazole may be a safe and effective treatment for meningoencephalomyelitis of unknown aetiology in dogs.

Atypical imaging appearances of intracranial meningiomas.

Meningiomas are the commonest primary, non-glial intracranial tumours. The diagnosis is often correctly predicted from characteristic imaging appearances. This paper presents some examples of atypical imaging appearances that may cause diagnostic confusion.

CT angiography of intracranial aneurysms related to arteriovenous malformations: a cautionary tale.

Computed tomographic angiography (CTA) has a high sensitivity and specificity for the detection of intracranial aneurysms and is increasingly used as the primary imaging modality in the investigation and pretreatment planning of patients presenting with acute subarachnoid haemorrhage. We present two cases in which CTA failed to demonstrate arteriovenous malformations associated with intracranial aneurysms.

Postoperative radiotherapy and mitoxantrone for anal sac adenocarcinoma in the dog: 15 cases (1991-2001).

The medical records of 15 dogs with anal sac adenocarcinoma (ASAC) treated with concurrent curative-intent radiotherapy and mitoxantrone (MX) after surgical removal of the primary tumour were reviewed retrospectively. Radiation was prescribed at 15 daily fractions of 3.2 Gy for a total dose of 48 Gy. MX was given intravenously at a dosage of 5 mg m(-2) every 3 weeks for five treatment sessions. Twelve dogs received pelvic irradiation to include the regional lymph nodes (LNs) and three received radiation only to the perineum. At the time of diagnosis, four dogs were hypercalcaemic and seven dogs presented with regional LN metastasis. All the dogs with regional LN metastasis received pelvic irradiation, and in three cases, metastatic LNs were treated in the macroscopic disease setting. The median event-free survival was 287 days, and the median overall survival was 956 days. Acute and chronic radiation complications were common and non-life threatening, although chronic complications contributed to the decision to euthanize two dogs. The results observed in this retrospective analysis compare favourably with cases of ASAC in the literature related to treatment with surgery and/or chemotherapy.

Radiographic diagnosis of a rectourethral fistula in a dog.

An English bulldog was referred to the Veterinary Medical Teaching Hospital-University of Wisconsin (VMTH-UW) for re-evaluation of an 8-year history of chronic, recurrent prostatitis and cystitis. The patient was first referred to the VMTH-UW at 11 months of age with a history of antibiotic-responsive hematuria and stranguria. Four urinary tract contrast studies were performed during the 8-year time span; however, a rectourethral fistula was not diagnosed until the fourth study. The article presents a literature review of rectourethral fistula, describes the case management of the dog in this study, and provides an explanation as to the potential reasons the fistula was not diagnosed on the three previous imaging studies.

Effects of pubic symphysiodesis in dysplastic puppies.

OBJECTIVE: To determine the long-term effects of juvenile pubic symphysiodesis (JPS) in dysplastic puppies. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS: Seven dysplastic Chesapeake Bay retrievers and 2 beagle-crosses (BX1 and 2). METHODS: Five puppies had JPS performed with electrocauterization at 12, 16, 20, 22, and 24 weeks of age, respectively. Two puppies served as controls. BX1 and BX2 were used to obtain biopsies of the symphysis. Hips were evaluated for: pelvic development (transverse computerized tomography for acetabular angle [AA] and dorsal acetabular rim angle [DARA]); laxity [hip extended and stress radiography [distraction index (DI)]); Ortolani maneuver with reduction angles; acetabular coverage (Norberg angles); and function (coxofemoral range of motion, hip pain, and gait analysis by force-plate technique at 44 and 137 weeks of age). RESULTS: The pubis fused prematurely in every puppy that was operated on with the JPS technique. Greater acetabular responses were related to younger ages at surgery. The final mean AA in dogs that had JPS was 25 degrees greater than preoperative values; 40% increased over control. The DARA final mean was 10 degrees, 52% less than preoperative values and 46% less than control. The final mean DI in dogs having JPS was 0.28, 47% improved over preoperative values and 58% better than control. Mean pelvic dimensions in dogs that had JPS were 18% less than control. Gait analyses were normal for all dogs at 137 weeks. No urinary or bowel complications occurred. CONCLUSIONS: Significant ventrolateral acetabular rotation, increased hip coverage, diminished hip laxity, normal pain-free gait, and insignificantly reduced pelvic size occurred after JPS. CLINICAL SIGNIFICANCE: Dysplastic hips in young dogs were significantly improved by JPS.

Postoperative radiotherapy for canine soft tissue sarcoma.

Thirty-five dogs with 37 soft tissue sarcoma tumors that were incompletely excised and treated with radiotherapy in the postoperative, adjuvant setting were reviewed. Variables evaluated included age, sex, tumor site, tumor histology, total tumor radiation dose, radiotherapy field size. time to recurrence, and survival. The majority of tumors were fibrosarcomas and hemangiopericytomas, but small numbers of other tumor types were also represented. Total tumor radiation dose ranged from 42 to 57 Gy given in 3- to 4.2-Gy daily fractions on a Monday through Friday schedule. Overall median survival was 1,851 days. Median time to local recurrence was greater than 798 days. Soft-tissue sarcoma tumors at oral sites had a statistically significant lower median survival (540 days) as compared to other tumor sites (2,270 days). Radiotherapy may be a useful adjuvant therapy for incompletely excised soft-tissue sarcomas with a reasonable expectation for long-term patient survival.